Diagnosis of gout

Acute gouty arthritis typically presents with rapid development of severe joint pain, swelling, and tenderness that reaches its maximum within just 6-12 h, especially with overlying erythema, most classically in the first metatarsophalangeal joint. Demonstrating the presence of monosodium urate (MSU) crystals in the joint fluid or tophus has been the gold standard for the diagnosis of gout. However, many physicians do not perform synovial fluid analysis. In the absence of demonstrating the presence of MSU crystals in aspirated joint fluid or tophus clinical, radiological and laboratory criteria are helpful. This paper presents an overview of the various classification criteria, clinical presentations, laboratory and radiological studies needed to make the diagnosis of gout.